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Influences On The Effectiveness Of Information Technology Innovations In Primary Health Care


Health information technology (HIT) represents one of the largest areas of innovation in health care in recent history. While earlier theoretical and empirical work has focused mostly on understanding the factors that lead health care providers or patients to use an HIT innovation, less is understood about whether and how this use leads to improved healthy behaviors or health outcomes. The first paper of this dissertation studies the relationship between the ease of use of electronic health records (EHR) and relational coordination among primary care team members. Support is found for the hypothesis that ease of use contributes to better team coordination through use of the EHR. The second paper is a mixed-methods study of a diabetes care management text- messaging intervention for low-income, Latino patients. We examine both the implementation and impact of the program, and find some evidence of improvements to blood glucose (HbA1c) among participants. The third paper studies the relationship between a text-messaging intervention for pregnant women in Samoa and antenatal care attendance. The findings suggest that the text-messaging intervention did not encourage, and might have even discouraged, antenatal care attendance. Together with findings on implementation barriers and facilitators, these findings are discussed in the context of other current literature on mHealth programs for maternal health. The three papers provide support for an overall conceptual model that draws upon earlier theoretical and empirical literature, and helps us to better understand the effectiveness of HIT innovations in a broad range of settings.

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